NAIROBI, Kenya, Apr 5 – Despite the milestones achieved across the world, there still remains much disparity and inequity in access to health care among women.
In Kenya, the Maternal Mortality Ratio (MMR) has remained at over 400 per 100,000 live births and recent statistics from the 2008/09 Kenya demographic and health survey (KDHS) show that only 44 per cent of births in the country were assisted by a skilled attendant.
While the roles of skilled birth attendants and emergency obstetric care in efforts to reduce mortality have been demonstrated extensively, functioning health systems that include trained and motivated health workers, equipped facilities and referral systems for complications are the key pre-conditions for their provision.
James Kipaipai has been a community health volunteer at the Imurtot Health Facility, located in Oloitoktok Sub-county, Kajiado for the last seven years.
On this day we find him preparing the facility’s tuk tuk (a three wheeled motorcycle) which has been specially fitted to ferry expectant mothers.
A call has come through from a Traditional Birth Attendant (TBA) – who has been trained and works closely with the Community Health Worker (CHW) – that a woman is in labour and needs to be rushed to the health center.
After consultations with the facility’s health officer, he hurriedly begins his journey, which is quite a distance and the state of the roads is disheartening but he drives on, almost unaware of the bumps on our way.
I can’t help but question the comfort of the ride to an expectant mother who is in labour!
As if reading my mind he says, “At first the women were hesitant to board the tuk tuk since most feared that it was not that stable and that they would fall off. But I had to convince them and I can say I have gained their trust,” said Kipaipai.
We finally arrive at the homestead of ole Serai, the TBA together with Kipaipai help Agnes into the back of the tuktuk where she lays on a specially made bench cum bed.
This is Agnes’s first pregnancy and she is more than glad to have her delivery done in a health facility, like many other women lined up for various maternal health services on this day.
On arrival, she is received by a nurse and quickly wheeled into the ward.
“I have seen many women suffer from complications arising from pregnancy, some lost their babies, some their lives while others have had to live with life threatening conditions,” she said.
“And for that reason upon learning that I was pregnant, I engaged the TBA who advised me on making sure that I should at least attend 4 Ante Natal Care (ANC) sessions, eat healthy and maintain hygiene. I have not experienced any complications during my pregnancy,” stated Agnes.
The success stories on improved healthcare resonate in most parts of rural Kajiado county where the CHWs in educating the community on the importance and need to seek maternal healthcare have tirelessly also worked to show the negative effects and or impacts of low education, low contraceptive use, Female Genital Mutilation and child marriage that derail women’s self-determination.
“This is my third born, and have delivered all my children in hospital, the advantage of delivering my children in hospital is that if there are any complications they can be attended to immediately and save me and the baby from other complications,” said Faith Joseph a beneficiary of the maternal healthcare.
In Mwingi, Kitui County, CHWs can be felt in every household as Bretta Kanini explains, “This area has for long faced serious water shortages, especially now we have the drought.”
“Regardless this doesn’t deter us from enlightening the communities on the importance of observing hygiene as well as seeking treatment in health facilities.”
Over the years, efforts to reduce maternal deaths have been a focal point of international agreements and a priority for women’s rights and groups throughout the world; the irony is that all maternal deaths are entirely preventable given proper surveillance and intervention.
There is no doubt that the CHWs are playing a big role at the grass root level by providing reports, data to help policy makers and shareholders with a road map that will help provide answers to improve maternal and child health as well as achieve higher health targets.
For this reason, Amref Health Africa, with support of the African Union, UN agencies, donors, African governments and the private sector launched the Community Health Worker campaign early last month.
The campaign to get community health workers paid and formally integrated into the health system has been rolled out across Africa.
Dr Githinji Gitahi, Amref Health Africa Group CEO said considering that more than 50 per cent of Africans do not access the formal health system, Community Health Workers are a critical and necessary part of the continent’s health infrastructure.
“In this campaign, we are advocating for the remuneration of community health workers and their inclusion into the formal health workforce,” said Dr Gitahi.
Currently, community health workers are neither paid nor remunerated in Kenya.
This is despite the critical role that they play in the health infrastructure, especially at the community level where many lack access to the formal health system.
These are people who live in communities they serve, providing a critical link between those communities and the primary health care system.
Much of the hesitation in incorporating them into the formal health system has been brought about by lack of data on what it would cost, even though the positive impact of their work has been recognised in many pilot programmes.
The campaign rolled out seeks to have the CHWs receive one year of training: three months in a classroom and nine months field under supervision.
In addition, each CHW is expected to receive a monthly salary of between Sh7,000-Sh10,000.
Dr Gitahi added that this was the ideal approach for Kenya; given the huge role the community health workers play in bridging gaps in the formal health workforce.
The World Health Organization (WHO) voiced its support for a community based health system, adding that this was where the health care need was most pressing.
“Community health workers need sustainable careers and stable income,” said Dr Matshidiso Moeti, Regional Director, WHO Africa Regional Office, underscoring the timeliness of the campaign.
Ethiopia is one such country whose strong political will has seen it become the benchmark for Africa’s community health worker strategy.
Through its health extension programme, Ethiopia has expanded disease prevention and primary care through service delivery to the communities at the grass-root level, with more than 35,000 community health workers currently on record.